- Research article
- Open access
- Published:
Social support and physical activity: does general health matter?
European Review of Aging and Physical Activity volume 21, Article number: 16 (2024)
Abstract
Background
Physical activity levels remain suboptimal in older adults. Exploration of potentially modifiable factors such as social support is needed to inform the development and implementation of patient-oriented physical activity interventions for older adults. The impact of general health on the relationship between social support and physical activity is not well understood. We aimed to determine the association between social support and self-reported physical activity in a study of community-dwelling older adults. In addition, we examined whether self-reported general health mediates the relationship between social support and self-reported physical activity.
Method
This cross-sectional study analyzed baseline data collected as part of a randomized controlled trial comparing a digital physical activity intervention, which included social support features, with a tablet-based educational control. Adults ≥ 60 years of age were enrolled at 2 sites. Self-reported general health, social support, physical activity, and sociodemographic characteristics and comorbid conditions were assessed. Pearson and point-biserial correlations were computed to evaluate the relationship between physical activity and general health, social support, and sociodemographic features. Social support (exposure), general health (mediator), and physical activity (outcome) were incorporated into a mediation model.
Results
Among 181 participants (mean age of 70.1 years), significant correlations were found between physical activity and both general health and social support (r = -0.19 and r = 0.21, respectively; both p < 0.01). General health significantly mediated the relationship between social support and physical activity (unstandardized ß coefficient 416.9; 95% confidence interval 96.4, 842.0).
Conclusions
Augmentation of social support, particularly when coupled with other modes of health promotion to improve personal wellbeing, may be a valuable component of physical activity promotion programs. Further longitudinal research is needed to clarify the potential mechanistic pathways linking social support, general health, and physical activity to inform development of evidence-based physical activity interventions for older adults and improve downstream health-related outcomes.
Trial Registration
ClinicalTrials.gov, ClinicalTrials.gov identifier NCT03538158. Registered May 25, 2018.
Background
Benefits of physical activity are well established in older adults, including reduced risk of cardiovascular disease, cerebrovascular disease, diabetes mellitus, some forms of cancer, as well as enhanced mental health and quality of life [1]. In recognition of these benefits, the United States Centers for Disease Control and the World Health Organization advise ≥ 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity per week, along with muscle strengthening activities ≥ 2 days per week and balance improvement activities 3 days per week for adults ≥ 65 years of age [2, 3]. Nevertheless, most studies report low rates of adherence to physical activity guideline recommendations among community-dwelling older adults [4]. For instance, in a recent cross-sectional study of participants ≥ 65 years of age in the National Health and Nutrition Examination Survey in the 2017–2018 wave, only 34.2% (95% confidence interval 30.2–38.3%) were found to meet physical activity guideline recommendations [5]. Older old adults, defined as ≥ 80 or 85 years of age, are especially prone to physical inactivity [4]. There may be variability in these adherence estimates due to use of different validated physical activity instruments, as well as differential age and geographic distributions among observational studies [4].
Considerable evidence supports the use of exercise interventions in the general population of older adults to enhance physical activity levels and improve downstream health-related outcomes [6, 7]. Exercise interventions incorporating resistance training, meditative movements, and active videogames, have been found to be particularly effective [7]. Nevertheless, optimal programming, including mode of delivery, intensity and duration of exercise, and accompanying features, has not been well defined [6, 7]. While multiple determinants of physical activity behavior in older adults, including age, gender, and walkability, have been identified, little is known about other potentially modifiable factors impacting physical activity behavior in older adults [8]. Exploration of additional factors is needed to inform development of physical activity interventions for older adults that will lead to durable treatment effects.
The positive influence of social support on physical activity is well studied. Social support has been found to promote self-efficacy, which in turn encourages physical activity [9, 10]. Older individuals with greater physical activity-related social support, particularly from family members, are generally more likely to engage in physical activity [11]. However, the relationship between overall social support (i.e., not specifically physical activity-related) and engagement in physical activity is less clear [11]. For example, in a 2017 systematic review of social support and physical activity among adults ≥ 60 years of age (including 22 cross-sectional, 3 prospective/longitudinal, and 2 interventional studies) physical activity-related social support was associated with increased levels of physical activity in 11 of 17 studies (65%) [11]. Only 4 studies (including 5 analyses), assessed the association between overall social support or engagement and physical activity, with 2 (40%) demonstrating a significant association [12,13,14,15]. In a 2022 systematic review of reviews on barriers and facilitators of physical activity in adults across the lifespan, higher levels of overall social support were associated with more leisure-time physical activity in 12 of 17 studies [16]. Other factors, such as general health, which could mediate the relationship between overall social support and physical activity in older adults have not been investigated as extensively.
Greater levels of self-reported general health have been associated with higher self-reported physical activity levels in multiple cross-sectional studies of the general adult population [17]. However, to our knowledge, limited attention has been devoted to disentangling the relationship of social support, self-reported general health, and engagement in physical activity. In this exploratory study, we aimed to determine the cross-sectional association between overall social support and self-reported physical activity in a sample of community-dwelling older adults. In addition, we examined whether self-reported general health mediates the relationship between overall social support and self-reported physical activity.
Methods
This study analyzed cross-sectional data collected as part of a randomized controlled trial that compared the Fittle Senior System (FSS), a digital physical activity intervention with social support features drawing on social cognitive theory [9, 18], with a digital educational control. The study protocol is summarized briefly below.
Protocol
Participants were enrolled at two academic medical centers in the United States. Following telephone pre-screening and informed consent, participants were assigned randomly in blocks of 3–6 individuals to receive either the FSS or an educational control. FSS arm participants received a tablet delivering pictorial and written instructions on physical exercises over a 12-week period, with team-based social support features in the form of 1-to-1 and group chat functions. Participants randomized to the educational control received a tablet preloaded with widely available content on physical exercise and safety tips.
Sample
Eligible participants were ≥ 60 years of age and able to speak English, read at the sixth-grade level, and pass the Telephone Interview for Cognitive Status [19]. Individuals with cognitive (defined by score < 26 on the Mini Mental Status Exam [20]) or visual (corrected or uncorrected visual acuity < 20/40) impairment, active participation in a structured physical exercise regimen, or health conditions that could affect their ability to participate were excluded. Recruitment was conducted through classified advertisements, virtual flyers, community newsletters distributed at senior centers and in geriatric clinics, virtual presentations, and social media advertisements.
Measures
Multiple measures were collected as part of the parent randomized controlled trial. Measures relevant to the current study are described below.
General health
General health was measured using the first question of the 36-Item Short-Form Survey (SF-36): “In general would you say your health is…?” Scores range from 1 (“excellent”) to 5 (“poor”) [21]. Due to use of a single measure, Cronbach’s alpha for general health could not be calculated.
Social support
Social support was measured using the 12-Item Interpersonal Support Evaluation List [22]. According to this scale, social support is measured across 3 subscales: appraisal, belonging, and tangible. Each item is scored on a 1 (“definitely false”) to 4 (“definitely true”) scale, including reverse coding for some prespecified items. We have reported the mean score, with a higher mean corresponding with more social support. In our sample, Cronbach’s alpha for social support was 0.87.
Physical activity
Physical activity was measured using the Global Physical Activity Questionnaire [23]. This 16-item scale assesses physical activity across multiple domains, including activity performed at work, during travel to and from places, and recreational activities, as well as sedentary behavior. Physical activities are clustered into moderate and vigorous physical activities, and physical activity levels are expressed as the total number of metabolic equivalent (met)-minutes per week. Attainment of ≥ 150 minutes of moderate-intensity or 75 min of vigorous-intensity physical activity per week or ≥ 600 metabolic equivalent-minutes per week of moderate and vigorous physical activity is consistent with adherence to United States Centers for Disease Control and the World Health Organization physical activity guidelines [2, 3]. Sedentary behavior based on the Global Physical Activity Questionnaire is expressed in terms of minutes per week [23]. World Health Organization physical activity guideline recommendations advise limiting sedentary activities without defining a specific goal threshold [3]. In a recent systematic review, reliability and validity of the Global Physical Activity Questionnaire were found to vary based on study population [24]. In our sample, Cronbach’s alpha for physical activity was 0.51.
Sociodemographic characteristics
Sociodemographic and related features, including age, gender, race, ethnicity, and comorbid conditions, were collected by self-report.
Analysis
Sample characteristics were summarized using descriptive statistics. Participants without complete data were excluded from subsequent analyses. Pearson and point-biserial correlations were computed to evaluate the relationship between self-reported physical activity and self-reported general health, social support, and sociodemographic and related features. For the main analysis, we conducted a mediation analysis with bootstrap confidence intervals. We incorporated social support (exposure), self-reported general health (mediator), self-reported physical activity (outcome), and the sociodemographic features of age, gender, and race and ethnicity (covariates) into the mediation model determined a priori based on review of the literature [11]. Figure 1 shows the mediation model. For model estimation, 5000 bootstrap samples were employed to attain 95% confidence intervals, which were deemed significant if they did not overlap with 0. SPSS Statistics 29 was used for statistical analysis.
Results
Sample characteristics
From 2018–2021, 471 potential participants were screened, and 228 were found initially to be eligible for randomization; 34 eligible individuals did not proceed to randomization: 12 were found to be ineligible on further assessment, 24 were lost to contact, 9 withdrew, and 1 was not randomized for other reasons. Baseline data were available for 181 randomized participants.
Sample characteristics are presented in Table 1. Participants had mean age of 70.1 years, were 80.1% women, with 13.4% self-identifying as Black or African American and 12.7% as Hispanic or Latino. Arthritis and hypertension were the most common self-reported comorbid conditions, present in 55.6% and 39.7%, respectively. Participants’ mean general health and social support scores were 2.4 [(standard deviation [SD] 0.8; range 1 (“excellent”) to 5 (“poor”)] and 3.1 (SD 0.6; range 0–4; higher score indicates more social support), respectively. Mean self-reported physical activity level was 1997.2 (SD 4538.7) metabolic equivalent-minutes/week while median self-reported physical activity level was 720.0 (interquartile range 0, 2055.0) metabolic equivalent-minutes/week. Mean self-reported sedentary activity was 406.9 (SD 204.9) minutes/week. Among 3 participants for whom complete baseline data were unavailable, mean age was 67.3 years, 2 were women, and 1 self-identified as Black or African American.
Correlations between physical activity and sociodemographic variables, general health, and social support
Pearson and point-biserial correlations between self-reported physical activity and sociodemographic variables, self-reported general health, and social support are displayed in Table 2. Complete data were available for analysis on 178 participants. Greater self-reported general health (r = -0.19, p < 0.01) and greater social support (r = 0.21, p < 0.01) were significantly correlated with greater self-reported physical activity levels.
Mediation Model
Table 3 shows the mediation model relating social support and self-reported physical activity, as mediated by self-reported general health, with age, gender, and race and ethnicity added to the model as covariates.
Social support had a significant direct effect on self-reported general health (unstandardized ß = -0.40, 95% CI [-0.59, -0.21]) (see Path a in Fig. 1 for the standardized coefficient). Self-reported general health had a significant direct effect on self-reported physical activity (unstandardized ß = -1051.13, 95% CI [-1974.03, -128.24]) (see Path b in Fig. 1 for the standardized coefficient). However, social support was not significantly associated with self-reported physical activity (unstandardized ß = 1172.83, 95% CI [-54.48, 2400.13]) (see Path c in Fig. 1 for the standardized coefficient). Most importantly, self-reported general health significantly mediated the effect of social support on self-reported physical activity as the indirect effect of self-reported general health on self-reported physical activity was significant (unstandardized ß = 416.9, 95% CI [96.4, 842.0]). General health accounted for 49.58% of the effect of social support on physical activity after accounting for the effect of covariates.
Discussion
In this exploratory study, we examined the association between overall social support and self-reported physical activity, as well as the role of general health as a mediator of this relationship in a sample of community-dwelling older adults. We found a significant association between overall social support and physical activity. However, we also found a significant mediating effect of general health on the relationship between overall social support and physical activity such that after controlling for self-reported general health, social support was no longer significantly associated with physical activity.
Our findings add to existing evidence on the association of social support with physical activity in older adults. In corroboration with some, but not all prior studies, we found a significant association between overall social support based on the 12-item Interpersonal Social Evaluation List and self-reported physical activity [22]. Heterogeneity in study design and modes of assessment of overall social support and physical activity levels may contribute to the observed differences among study findings. Additional studies in larger samples of community-dwelling older adults are needed to clarify the association between overall social support and physical activity. Evaluation of the relationship of specific aspects of social support with physical activity is also warranted as this will identify the type of social support that has the most impact on engagement in physical activity, which will inform future interventions.
Our findings highlight general health as a significant mediator of the relationship between overall social support and physical activity in older adults. We hypothesize that an individual’s perceived general health status may impact both their ability to seek and/or accept social support and their ability and/or motivation to engage in physical activity. As social support is known to be protective against depression in older adults [25], enhanced social support may lead to enhanced perception of general health by reducing depression, thereby facilitating engagement in physical activity. Further, as social support may be associated with physician utilization [26], greater social support may improve general health by encouraging routine ambulatory care visits, creating opportunities for counseling regarding the benefits of a physically active lifestyle. Our findings suggest that perceived general health should be considered in interventional studies aimed at improving physical activity via social support enhancement strategies. This may be particularly important in older adults with chronic conditions, who tend to have worse perceived health [27].
Our study has several limitations. The cross-sectional nature of this analysis precludes causal inferences, though the directionality of the mediation model is rooted in the existing literature [11]. Participants were enrolled at two sites in the United States, potentially limiting generalizability of our findings to individuals from other countries or regions. Our study was conducted during the height of the Covid-19 pandemic, which likely impacted social support [28] and physical activity levels [29]. Further, participants were, on average, physically active by self-report; the extent to which our results can be extended to physically inactive individuals is not clear. Finally, we used a self-reported measure of physical activity, which is known to be incompletely concordant with objective physical activity levels and often over-reported [30]. Collection of objective measures of physical activity was not feasible as this study was conducted at the height of the Covid-19 pandemic.
Conclusions
Our results highlight individual perception of general health as an important mediator of the relationship between social support and physical activity, suggesting that attention to general health status is needed to optimize the potential benefits of social support in the context of physical activity promotion. Future research incorporating longitudinal designs and involving racially and ethnically diverse older adults is needed to clarify the potential mechanistic pathways linking social support, general health, and physical activity to inform development of evidence-based physical activity interventions for older adults and thereby improve downstream health-related outcomes.
Availability of data and materials
The data underlying this article cannot be shared publicly due to the privacy of individuals who participated in the study. De-identified data will be shared on reasonable request to the corresponding author after Institutional Review Board approval and completion of a data use agreement.
Abbreviations
- FSS:
-
Fittle Senior System
- SF-36:
-
36-Item Short-Form Survey
- SD:
-
Standard deviation
- CI:
-
Confidence interval
References
Langhammer B, Bergland A, Rydwik E. The importance of physical activity exercise among older people. Biomed Res Int. 2018;2018:7856823.
Piercy KL, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8.
Organization, W.H., WHO Guidelines on Physical Activity and Sedentary Behavior. 2020: Geneva.
Sun F, Norman IJ, While AE. Physical activity in older people: a systematic review. BMC Public Health. 2013;13:449.
Xu L, et al. Prevalence of sufficient physical activity among general adult population and sub-populations with chronic conditions or disability in the USA. Eur J Public Health. 2023;33(5):891–6.
Grande GD, et al. Interventions Promoting Physical Activity Among Older Adults: A Systematic Review and Meta-Analysis. Gerontologist. 2020;60(8):583–99.
Di Lorito C, et al. Exercise interventions for older adults: A systematic review of meta-analyses. J Sport Health Sci. 2021;10(1):29–47.
D’Amore C, et al. Determinants of physical activity in community-dwelling older adults: an umbrella review. Int J Behav Nutr Phys Act. 2023;20(1):135.
Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26.
Anderson ES, et al. Social-cognitive determinants of physical activity: the influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychol. 2006;25(4):510–20.
Smith GL, et al. The association between social support and physical activity in older adults: a systematic review. Int J Behav Nutr Phys Act. 2017;14:56.
Kaplan MS, et al. Demographic and psychosocial correlates of physical activity in late life. Am J Prev Med. 2001;21(4):306–12.
Mowen A, et al. The role of park proximity and social support in shaping park visitation, physical activity, and perceived health among older adults. J Phys Act Health. 2007;4(2):167–79.
Potts M, et al. Social support, health promotive beliefs, and preventive health behaviors among the elderly. J App Gerontology. 1992;11(4):425–40.
Vance D, et al. Correlates of individual physical activities in older adults. Act Adapt Aging. 2008;31(4):1–21.
Garcia L, et al. Barriers and facilitators of domain-specific physical activity: a systematic review of reviews. BMC Public Health. 2022;22(1):1964.
Bize R, Johnson JA, Plotnikoff RC. Physical activity level and health-related quality of life in the general adult population: a systematic review. Prev Med. 2007;45(6):401–15.
Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64.
JB SM, and F MF, The Telephone Interview for Cognitive Status. . Neuropsychiatry, Neuropsychol, Behavioral Neurol, 1988. 1: p. 111–7.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Ware JE, et al. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33(4 Suppl):AS264–79.
Cohen S. et al. Measuring the functional components of social support, in Social Support: Theory, Research, and Application, Sarason, Editor. 1985, Martinus Nijhoff: Hague, Netherlands. 73-94.
Organization, W.H. Global Physical Activity Questionnaire: WHO STEPwise Approach to NCD Risk Factor Surveillance. 2005; Available from: https://www.who.int/publications/m/item/global-physical-activity-questionnaire.
Keating XD, Zhou K, Liu X, Hodges M, Liu J, Guan J, et al. Reliability and Concurrent Validity of Global Physical Activity Questionnaire (GPAQ): A Systematic Review. Int J Environ Res Public Health. 2019;16(21):4128. https://doi.org/10.3390/ijerph16214128.
Schwarzbach M, et al. Social relations and depression in late life-a systematic review. Int J Geriatr Psychiatry. 2014;29(1):1–21.
Bremer D, Inhestern L, von dem Knesebeck O. Social relationships and physician utilization among older adults-A systematic review. PLoS ONE. 2017;12(9):e0185672.
Yang H, et al. Association of self-rated health with chronic disease, mental health symptom and social relationship in older people. Sci Rep. 2021;11(1):14653.
MacLeod S, Tkatch R, Kraemer S, Fellows A, McGinn M, Schaeffer J, et al. COVID-19 era social isolation among older adults. Geriatrics (Basel). 2021;6(2):52. https://doi.org/10.3390/geriatrics6020052.
Oliveira MR, et al. Covid-19 and the impact on the physical activity level of elderly people: A systematic review. Exp Gerontol. 2022;159:111675.
Prince SA, et al. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.
Acknowledgements
Not applicable.
Funding
SBL is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR002385 and the Hospital for Special Surgery Fund for the Future. MCR is supported by the National Institute on Aging of the National Institutes of Health under Award Number K24AG053462. SJC and this study were supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG053163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author information
Authors and Affiliations
Contributions
All authors made substantial contributions to the conception and design of the current study and the interpretation of data and have approved the submitted version. SBL drafted the work, and the remaining authors substantially revised it. JM made substantial contributions to the analysis of data.
Authors’ information
Not applicable.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was approved by the Weill Cornell Medicine Institutional Review Board (#1806019352).
Consent for publication
Not applicable.
Competing interests
LAM reports research grants from Regeneron Pharmaceuticals, royalties from UpToDate, and salary support from Annals of Internal Medicine.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Lieber, S.B., Moxley, J., Mandl, L.A. et al. Social support and physical activity: does general health matter?. Eur Rev Aging Phys Act 21, 16 (2024). https://doi.org/10.1186/s11556-024-00347-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s11556-024-00347-6